BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BARD ACCESS SYSTEMS, INC.

    MDR report key: 309643 · Received December 20, 2000

    Report

    Report Number
    309643
    Event Type
    Malfunction
    Date Received
    December 20, 2000
    Date of Event
    October 10, 2000
    Report Date
    November 4, 2000
    Manufacturer
    BARD ACCESS SYSTEMS, INC.
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    WHILE MEASURING A PICC LINE FOLLOWING REMOVAL THE CATHETER BROKE NEAR THE HUB. THERE WAS NOT EXCESSIVE PULLING UTILIZED WHEN IT BROKE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD ACCESS SYSTEMS, INC. PERQCATH (PICC LINE) DQO BARD ACCESS SYSTEMS, INC. UNK 22EK 2584

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Other